Endoscopic appendectomy has many advantages over open appendectomy. But not all patients are eligible for laparoscopic treatment.
Indications and contraindications
What are the indications for laparoscopic appendectomy? Let's list them:
- clinically and laboratory confirmed acute and chronic inflammation of the appendiceal process;
- suspicion of appendicitis (as a diagnostic procedure);
- the desire of the patient, if the absence of a cosmetic defect is important to him.
Despite the minimally invasive removal of appendicitis using the laparoscopic method, there are contraindications to this procedure:
- myocardial infarction;
- impairment of cardiac, respiratory and renal functions;
- third trimester of pregnancy;
- peritonitis;
- the presence of abscesses;
- inflammation of the dome of the cecum;
- strong adhesive process.
Advantages and disadvantages
Laparoscopic appendectomy, in comparison with classical one, has the following advantages:
- minimal cosmetic defect;
- minimal tissue trauma;
- short-term recovery period - already on the third day after the operation the patient is discharged from the hospital;
- ability to work is quickly restored;
- low likelihood of complications (the most common is adhesive disease);
- the laparoscopic method is the most cost-effective, since less money is spent on ensuring the patient’s stay in the hospital;
- the opportunity during the operation to assess the condition of neighboring organs (ovaries, uterus, etc.);
- invisibility of the scar after a few months;
- laparoscopy can be used not only for treatment, but also for diagnosing and confirming inflammation of the appendix.
Despite all the advantages, removal of appendicitis using the laparoscopic method has disadvantages, but their number is minimal:
- expensive equipment;
- the need for staff training;
- impossibility of performing manipulation in some patients.
Preparation
Removing appendicitis by laparoscopy requires preparation. Even in case of emergency intervention, in addition to examination, the following diagnostic procedures are performed:
- general blood and urine analysis;
- testing for HIV and hepatitis;
- test for syphilis;
- coagulogram;
- if indicated - ECG.
The examination is carried out in the reception department. The patient is then sent to the surgical hospital, where he is interviewed by an anesthesiologist and a surgeon. If complications occur, surgery is performed as an emergency. In doubtful cases, diagnostic laparoscopy is performed.
Immediately before the operation, the patient is infused with glucose and saline solution, and the surgical field is treated.
Progress
Laparoscopic appendectomy is performed under local or general anesthesia. The patient is placed horizontally on a table tilted to the left. Then three punctures are made in the peritoneum. Their location depends on the location of the appendix.
The first puncture, into which a laparoscope with a camera is inserted, is made above the navel. The second (for the trocar) is between the womb and the navel. The third - depending on the location of the vermiform appendix.
After the needle passes through the skin, subcutaneous tissue and enters the abdominal cavity, carbon dioxide is injected. The abdomen increases in size, which allows for free manipulation and improves visualization of organs. After identifying and ligating the appendix, it is cut off. Then the abdominal organs are examined to exclude complications. If necessary, install drainage. The last stage of removing the appendix using the laparoscopic method is suturing the punctures.
Rehabilitation
Despite the fact that laparoscopy for appendicitis is a minimally invasive operation, rehabilitation is still necessary after it.
In the first 6 hours after the intervention, the patient is prohibited from getting up. On the third day the patient is discharged from the hospital. Sutures are removed 7-10 days after laparoscopy of the appendix.
Immediately after surgery, pain in the puncture area is possible. In this case, painkillers are prescribed (Analgin, Ketorolac). Also, all patients are prescribed antibacterial drugs (Dalacin, Metrogyl, Tienam).
The diet on the first day after surgery includes liquid food and drink. In the following days, regular foods are included in the diet.
Complete rehabilitation will take about 2 months. During this period, it is prohibited to lift heavy objects or perform excessive physical activity. The patient is allowed to work after the stitches are removed, if his profession does not involve lifting heavy objects.
Possible complications
Laparoscopic removal of appendicitis is rarely accompanied by any complications. But in rare cases, the following conditions may occur:
- hernia of the anterior abdominal wall;
- bleeding into the peritoneal cavity;
- typhlitis - a superficial burn of the cecum as a result of careless handling of the coagulator. The process is accompanied by an increase in temperature and pain;
- secondary infection in the area of sutures or removal of the appendix;
- abscesses, peritonitis - occur less frequently than with classic removal of the appendix.
Duration
Preparation for laparoscopic appendectomy lasts no more than 2 hours. The duration of the operation itself depends on the experience of the surgeon. On average, the manipulation takes no more than 20-30 minutes.
Price
The cost of endoscopic appendectomy depends on the materials and equipment used. The average price in Russia for this surgical intervention is 50,000 rubles. If a stapler is used for suturing the stump, this figure increases. The use of the ligature method significantly reduces the cost of the intervention; in this case, the price varies within 40,000 rubles.
Laparoscopy for appendicitis has many advantages over the classical method of appendix removal. This is low invasiveness, short recovery time after the intervention, and minimal cosmetic defect. However, this technique also has contraindications and disadvantages. But the low chance of complications combined with the advantages makes the laparoscopic method of removing the appendix the method of choice in the treatment of appendicitis.
Useful video about laparoscopy of appendicitis
The development of acute appendicitis, that is, inflammation of the appendix of the rectum in most cases leads to the need for emergency surgical intervention. In most cases, surgery to remove an inflamed appendix is performed using the traditional method. But modern medicine allows patients to choose endoscopic intervention, which has a number of significant advantages.
What is endoscopic surgery
Endoscopic surgery is a minimally invasive operation, also known as laparoscopy. Currently, this method of emergency treatment is used not only in special medical centers; endoscopy is quite successfully and competently used in ordinary hospitals. Laparoscopy is performed using special endoscopes - metal or plastic tubes with a minimum diameter and equipped with an optical system. The endoscope is inserted into the required location through a small incision on the abdominal wall, the optical system records all changes, and the doctor evaluates them on a computer. Endoscopic intervention achieves two goals, that is, it is carried out as a diagnostic or therapeutic procedure. If, as a result of laparoscopy, indications for surgical intervention are identified, the operation will be performed immediately.
Endoscopy is successfully used in urology, gastroenterology, gynecology, and surgery. The possibilities of endoscopic intervention are only expanding from year to year. Removal of the inflamed appendix using laparoscopy is also being used more and more often, and patients, if given the choice, prefer this type of surgical intervention.
Advantages of endoscopy in the development of appendicitis
Removal of appendicitis in the acute stage of inflammation is indicated for almost all patients. If the operation is not performed on time, perforation may develop, purulent contents may escape from the appendix and peritonitis may develop. Such a complication is dangerous for the patient and always requires extensive abdominal surgery.
Traditional surgery to remove appendicitis involves making an incision in the abdominal wall. If an inflamed appendix is detected, it is cut off, the abdominal cavity is sanitized, and the incision is sutured in layers. The general recovery period after uncomplicated surgery lasts from two to three weeks. After a classic operation, the patient is left with a suture in the lower abdomen; its length is usually about 10 centimeters. But with severe obesity, such a seam can be much longer in length.
Endoscopic surgery to remove an inflamed appendix has a whole group of advantages, the most important of which include:
- Lowest number of complications. A small incision heals faster, the patient does not experience excessive bleeding and the likelihood of infection of the postoperative wound is minimal.
- Short recovery period. After endoscopic intervention, the patient can be sent home the next day. Healing occurs within a few days, pain is minimal and good health has virtually no effect on light work activity.
- Cosmetic effect. Endoscopy allows for a small examination; after complete healing of the wound, the scar is practically invisible.
- Laparoscopic intervention allows a more accurate diagnosis. That is, after inserting an endoscope, a diagnosis may be made not of appendicitis, but of a completely different acute pathology. At the same time, a decision is made on the need for further surgical intervention or possible conservative treatment.
Removing the appendix using endoscopic intervention significantly reduces the risk of developing adhesions. People often develop adhesions after appendicitis, which in some cases requires further surgery. It is not always possible to remove the appendix using laparoscopy; the doctor takes into account the indications and all contraindications before choosing a method of surgical treatment.
Indications for endoscopy in the development of appendicitis
Laparoscopy today is not a rare operation, but certain requirements are imposed on its use for the removal of an inflamed appendix. The main indications for endoscopy in the development of appendicitis are:
- Situations when the diagnosis of acute appendicitis is questioned. Carrying out diagnostics using endoscopic equipment makes it possible to find out whether there is inflammation of the appendix or the clinical picture of an acute abdomen is caused by a completely different pathology.
- Endoscopic intervention is often offered to patients with severe obesity. This minimally invasive removal of the appendix allows you to quickly gain access to the cecum and reduces the possibility of developing a purulent process, which often occurs against the background of obesity.
- Appendicitis developing against the background of diabetes mellitus. Such a disease often leads to the development of various complications in the postoperative period, one of which is long wound healing. Endoscopy provides a short recovery period.
Naturally, the patient himself can choose endoscopic intervention. If there are no contraindications and there is a choice, the operating surgeon usually performs laparoscopy. Contraindications for which removal of the appendix by endoscopic intervention is not possible include:
- Acute appendicitis, the clinical picture of which lasts for more than a day. With prolonged inflammation, infiltration, peritonitis and abscesses may develop.
- Diffuse peritonitis, this disease requires sanitation of the entire abdominal cavity and the creation of drainage for the release of pus.
- General contraindications. Endoscopy is not performed in cases of acute myocardial infarction and severe cardiovascular failure, or in obstructive pulmonary pathologies.
When choosing the method of appendectomy, the surgeon takes into account all the indications, the patient’s well-being, and contraindications. Based on examination, questioning, and laboratory data, a decision is made on the method of surgical intervention.
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Spirographic diagnosis of disorders of the ventilation function of the lungs Perelman Yu.M., Prikhodko A.G.rar -
Directory for emergency care Eliseev O.M.rar -
Standards of medical care for emergency medical care, Miroshnichenko A.G., Shaytor V.M.rar -
Theoretical background and practical basis of nutritional support in a critical illness clinic. Ed. Usenko L.V., Maltseva L.A.rar -
Test tasks in anesthesiology and resuscitation Lyzikova T.V., Alekseeva L.A..rar -
Techniques of intensive care in pediatrics. Ed. Romanenko V.A., Sparlinga D.rar -
Technical techniques of intensive care in pediatrics Gromov Yu.A. Zhuchenko V.K.rar -
Transfusiology in resuscitation. Ragimov A.A., Eremenko A.A., Nikiforov Yu.V.rar -
Transfusiology for anesthesiologist-resuscitator Shlakhter S.M.rar -
Tracheostomy. Modern technologies, Sukhorukov V.P.rar -
Tracheostomy in neurosurgical patients Fokin Goryachev.zip -
Tracheostomy Shlyaga I.D., Ermolin S.V.rar -
Difficulties in tracheal intubation Latto I.P., Rosen M..rar -
Difficult airway from the position of an anesthesiologist-resuscitator - a manual for doctors. Molchanov I.V.rar -
Difficult airway from the position of an anesthesiologist-resuscitator Molchanov I.V., Zabolotskikh I.B., Magomedov M.A..rar -
Ultrasound studies in the provision of infusion therapy in intensive care units Bykov M.V.rar -
Ultrasound studies in the provision of infusion therapy in intensive care units Bykov M.V..rar -
Urgent sonography of the lungs in acute respiratory failure Kyiv, Sonomir, 2012.rar -
Pharmacotherapy of acute pain Lebedeva R.N., Nikoda V.V..zip -
Physiology and pathophysiology of artificial lung ventilation Belebezev G.I., Kozyar V.V..rar -
Functional and laboratory tests in intensive care Koryachkin V.A., Strashnov V.I., Chufarov V.N., Shelukhin D.A..zip -
Traumatic brain injury. Current principles of uncomplicated assistance Pedachenko.rar -
Percutaneous catheterization of central veins Rosen M., Latto Y. P., Ng W. Sheng.rar -
Shock. Theory, clinic, organization of anti-shock care Mazurkevich Bagnenko.zip -Get a book on medicine
Emergency medical care at the prehospital stage Volny I.F., Posternak G.I., Peshkov Yu.V., Tkacheva M.Yu.rar -Get a book on medicine
Emergency medical care for poisoning R. Hoffman, L. Nelson, M.-E. Howland, N. Lewin, N. Flomenbau.m, L. Goldfrank.rar -
Emergency care for injuries, pain shocks and inflammations. Experience in emergency situations Yakovlev V..rar -
Enteral clinical nutrition in intensive care medicine Luft V.M..rar -
Etudes of critical medicine Volume 1. Medicine of critical conditions_ general problems Zilber A.P..rar -
Efferent methods of treatment of acute poisoning. Dedenko I.K., Starikov A.V., Litvinyuk V.A., Torbin V.F.rar -
Dear readers!
We present to your attention an electronic exhibition of books from the collections of the regional scientific medical library MIAC on the topic “Intensive Care”. Each publication is accompanied by a bibliographic description with a brief annotation. If you activate the cover of the publication that interests you, you will be able to familiarize yourself with its contents. We hope that the new books will be useful to you.
Intensive care [Text]: national guidelines / ch. ed. B. R. Gelfand, A. I. Saltanov; ASMOK, Federation of Anesthesiologists and Reanimatologists, Russian Federation. assoc. specialists in surgical infections. - Moscow: GEOTAR-Media, 2009. - 956 p. : ill.
Annotation:
The book is an original guide to intensive care, which includes, based on careful selection, key data on the most important issues in the diagnosis and initial stages of treatment of various diseases and critical conditions. All topics in this publication are covered according to a single plan and their volume fits within the framework of one page of text, and the search for questions of interest to the reader is facilitated thanks to the alphabetical index. The publication is intended for practical primary care clinicians.
Intensive care [Text]: national guidelines / ch. ed. B. R. Gelfand, A. I. Saltanov; ASMOK, Federation of Anesthesiologists and Reanimatologists, Russian Federation. assoc. specialists in surgical infections. - Moscow: GEOTAR-Media, 2009. - 784 p. : ill.
Annotation:
The manual contains modern information on the diagnosis and treatment of critical conditions of various etiologies and pathogenesis. Thanks to the unification of leading Russian specialists in the team of authors, it was possible to create a guide that reflects a coordinated position on topical issues of modern intensive care. All recommendations have undergone an independent peer review process. The publication has an appendix on a CD, which includes information materials and links to high-quality Internet resources. The manual is intended for doctors of all specialties, senior students of medical universities, interns, residents, and graduate students.
Shurygin I. A. Breath monitoring in anesthesiology and intensive care [Text] - St. Petersburg. : Dialect, 2003. - 416 p. : ill.
Annotation:
The book provides detailed information on the use of non-invasive respiratory monitoring in anesthesiology and intensive care. The technical, physiological and clinical aspects of methods for monitoring respiratory mechanics and pulmonary gas exchange are considered. Numerous examples show how to use monitors and monitoring systems to ensure patient safety. Much attention is paid to the issues of in-depth interpretation of the data obtained and their use for decision-making in various clinical situations. For anesthesiologists, resuscitators, emergency doctors and other specialists who use monitor control methods in their work.
Marino P. L. Intensive care [Text] / trans. from English, ed. A.P. Zilber. - Moscow: GEOTAR-Media, 2010. - 768 p. : ill.
Annotation:
This book is a translation of the latest, third, world-famous edition of the fundamental manual written by Professor Paul Marino of the University of Pennsylvania, USA, “The ICU Book”. It presents the most modern and relevant information about hemodynamic and metabolic monitoring, the pathophysiology of critical conditions, modern methods of their diagnosis and treatment. Particular attention is paid to the selection of adequate treatment, which is very valuable given the tendency of many doctors to polypharmacy, as a result of which the risk of iatrogenic complications increases and economic costs unreasonably increase. The material is accompanied by numerous clinical examples and summary tables that facilitate the perception of information. The appendices describe the features of pharmacotherapy, the doses and routes of administration of a number of drugs, provide schemes and algorithms for resuscitation and diagnostic measures, reference tables for calculating the various needs of the body, international systems for assessing the severity of the patient’s condition, and outline measures to prevent infections and a hemodynamic profile. The book will be useful not only to specialists in the field of intensive care and resuscitation, but also to doctors of other specialties, as well as senior students of medical institutes.
Marino P. L. The ICU book [Text] / with contributions from Kenneth M. Sutin. - Philadelphia: Lippincott Williams & Wilkins, 2007: ill.
Annotation:
The third edition of the book has remained the fundamental textbook on intensive care for more than 15 years. When writing this publication, the author, as before, pursued the goal of creating a textbook that would contain the basics and principles of patient treatment and could be used in any intensive care unit, regardless of the department’s profile. Highly specialized critical care areas such as obstetric emergencies, burn care and neurological emergencies were not considered. Most of the book's chapters have been completely revised, and two new chapters have been included on infection control in intensive care units and diseases associated with thermoregulation. Most chapters are accompanied by a final section, which briefly presents the main points of the chapter read. Literature references have been significantly updated, focusing on recent research and recommendations used in clinical practice.
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